Apparatus and method for applying latchless surgical clips

ABSTRACT

A disposable apparatus is disclosed for applying latchless surgical clips to body tissue in endoscopic surgical procedures. The latchless clips are resiliently biased to a closed configuration. The apparatus includes a frame which is adapted to be gripped by hand, and an endoscopic section connected to the handle and capable of storing surgical clips in preparation for clipping arteries or other body tissue. The apparatus includes means for advancing each clip sequentially, temporarily opening the clip and advancing the clip further to a pair of distal jaws where the clip is positioned around the body tissue and closes around the tissue. Also included are means for closing the jaws about the clip. When the jaws are closed, the clip advancing means is simultaneously positioned to advance the next clip. The present apparatus also makes it possible to partially close a clip without interfering with the sequential movement of the clip advancing mechanism.

CROSS REFERENCE TO RELATED APPLICATIONS

This is a continuation-in-part of U.S. application Ser. No. 626,841,filed Dec. 13, 1990 .Iadd.now U.S. Pat. No. 5,366,458.Iaddend..

BACKGROUND OF THE INVENTION

1. Field of the Invention

This invention relates to an apparatus and method for applying surgicalclips, especially hemostatic clips, to body tissue such as bloodvessels. More particularly, this invention relates to a surgical clipapplier which can be used in laparoscopic or endoscopic procedures forclosing ducts, arteries and the like, and to a method for using same.

2. Background of the Art

In surgical operations it is often necessary to apply hemostatic clipsto blood vessels, and apparatus for applying clips are known in the art.See, for example, U.S. Pat. No. 4,616,650 and 4,624,254, both of whichare hereby incorporated by reference in their entirety, which disclose asurgical clip applying apparatus having ring-like handles. The handlesare squeezed to force jaws to move distally relative to the apparatuswhere they are forced together by a pair of inclined surfaces. Asurgical clip between the jaws is thereby squeezed closed.

While the instruments described in the above-referenced patents haveprovided beneficial features to surgeons in conventional surgicalprocedures, they are not useful in endoscopic or laparoscopicoperations. In laparoscopic procedures surgery is performed in theinterior of the abdomen through a small incision; in endoscopicprocedures surgery is performed in any hollow viscus of the body throughnarrow endoscopic tubes inserted through small entrance wounds in theskin. Laparoscopic and endoscopic procedures generally require that anyinstrumentation inserted into the body be sealed, i.e., provisions mustbe made to ensure that gases do not enter or exit the body through thelaparoscopic or endoscopic incision as, for example, in surgicalprocedures in which the surgical region is insuffiated. Moreover,laparoscopic and endoscopic procedures often require the surgeon to acton organs, tissues, and vessels far removed from the incision, therebyrequiring that any instruments to be used in such procedures be bothlong and narrow. In either laparoscopic or endoscopic surgery, thefunctional portion of the instrumentation is controlled from outside thebody. Mechanical actuation of such instruments is for the most partconstrained to movement of the various components along a longitudinalaxis, even if lateral movement is employed at the operating site. Theinitial opening in the body tissue to allow passage of the endoscopictube to the interior of the body can be a natural passageway of the body(e.g. bronchial tubes), or it can be created by a tissue piercinginstrument such as a trocar. Because the endoscopic or laparoscopictubes, instrumentation, and any required puncture are relatively narrow,endoscopic or laparoscopic surgery is less invasive and causes much lesstrauma to the patient as compared with procedures in which the surgeonis required to cut open large areas of body tissue.

An endoscopic apparatus for applying surgical clips is described in U.S.Pat. Nos. 5,084,057 and 5,100,420, both of which are incorporated hereinby reference in their entirety. The apparatus described in these patentsapply generally U-shaped or V-shaped clips fabricated from a metal suchas titanium or stainless steel. The clips are positioned between thejaws of the instrument which are then closed to squeeze the clip legstogether.

As an alternative to metal, polymers are also used to fabricate surgicalclips. The polymers can be bioabsorbable or non-bioabsorbable. Surgicalclips fabricated from polymers are described in U.S. Pat. Nos.4,418,694; 4,476,865; 4,492,232; 4,512,345; 4,527,562; 4,557,263;4,590,937; 4,620,541; 4,638,804; 4,646,741; and 4,741,337. Bioabsorbablepolymers include, for example, homopolymers and copolymers of lactide,glycolide, caprolactone and p-dioxanone. These polymers have theadvantage of decomposing in the body after a period of time. A separateoperation to remove them is unnecessary. Therefore, they can be used insituations where the clip is not intended to be permanently placed inthe body. Non-bioabsorbable polymers which are known to be useful forthe manufacture of surgical clips include polyesters, polyamides,polycarbonates, polyvinyl chlorides, polysulfones, and polypropylenes.

Up to the present, polymeric clips have been latched, i.e. the opposing"arm" or "leg" members which clamp the body tissue lock together bymeans of some type of latch mechanism. More recently, another type ofpolymeric surgical clip has been developed which is latchless. Alatchless polymeric surgical clip is disclosed in commonly assigned U.S.patent application Ser. No. 07/626,841, filed Dec. 13, 1990, hereinincorporated by reference in its entirety. Up to the present, it hasbeen desirable to develop an apparatus for applying latchless clips. Thepresent invention provides an apparatus and method for applying suchlatchless clips.

SUMMARY OF THE INVENTION

An apparatus is disclosed for applying latchless surgical clips to bodytissue. The latchless clips each possess a pair of legs movable betweena closed position wherein the legs are in relatively close proximity toeach other and an open position wherein the legs are relatively spacedapart from each other. The legs are resiliently biased to the closedposition. The apparatus comprises frame means, and endoscopic means ofgenerally elongated configuration connected to the frame means andextending distally therefrom. The endoscopic means includes: means forstoring a plurality of latchless surgical clips, means for opening theclips, means for selectively advancing the clips to the distal portionof the endoscopic means for positioning adjacent the body tissue to beclipped where the clips are permitted to at least partially close; andmeans for facilitating substantially complete closure of each clip atleast sufficient to grip the body tissue. The apparatus may becompletely disposable and the endoscopic means may be replaceable so asto permit additional clips to be applied with a single apparatus duringa single surgical procedure.

In one embodiment, a disposable apparatus is disclosed for applyingsurgical clips to body tissue which comprises a frame configured anddimensioned for manual gripping, an elongated endoscopic sectionconnected at the proximal end thereof to the frame and extendingdistally therefrom, the endoscopic section including means for storing aplurality of latchless surgical clips in generally aligned relationfacing the distal portion thereof, jaw means positioned at the distalend thereof and adapted for sequential reception of the latchless clips,means for sequentially advancing and opening the latchless clipsdistally so as to be positioned between the jaw means for positioningadjacent the body tissue to be clipped, and means for sequentially atleast partially closing the jaw means about each clip after the clip isadvanced therebetween while simultaneously repositioning the clipadvancing means for distal advancement of the next clip.

Preferably, an instrument body is provided and an actuating handlemounted to the instrument body, with first transmission means forlinearly transferring motion from the actuating handle to the clipadvancing means and means to close the jaw means. Second transmissionmeans is provided for linearly transferring motion from the actuatinghandle to the jaw closing means, and means is provided for locking thehandle such that after actuating the handle to close the jaws the handlecannot be actuated unless the locking means is released. The endoscopicsection is rotatable independent of the handle, with means beingprovided to selectively lock the endoscopic section at a predeterminedangular orientation relative to the handle. Means is provided to releasethe lock means of the endoscopic section so as to permit rotationthereof relative to the handle. Handle locking means comprises a firstresilient catch movable in response to actuation of the handle from anunlocked position to a locked position wherein the first transmissionmeans is advanced and locked. Release means is adapted to release thefirst resilient catch, the first resilient catch being returnable to theunlocked position in response to actuation of the release means. Asecond resilient catch is movable in response to actuation of the handlefrom an unlocked position to a locked position wherein it engages andlocks the second transmission means. The second resilient catch isresiliently returnable to the unlocked position in response to therelease of the resilient catch. The first transmission means comprisesmeans responsive to actuation of the release means to release the secondtransmission means.

The jaw means preferably comprises a pair of jaws positioned in spacedrelation and configured and dimensioned for reception of a latchlesssurgical clip therebetween. The jaws are resiliently movable toward andaway from each other in response to distal movement of a camming meansfrom a proximal position to a distal position. The camming meanscomprises a channel member slidably mounted within the endoscopicsection and longitudinally movable in response to actuation of thehandle, the channel member having at least two distal camming surfacesfor biasing the jaws into the closed position. Means for storinglatchless surgical clips comprises a track for holding a longitudinalarray of latchless surgical clips, and resilient means located proximalto the array of latchless surgical clips for biasing the clips towardthe distal direction. A clip track is positioned between the jaw meansand The clip follower. Means for advancing the latchless surgical clipscomprises a pusher bar for individually advancing the distal-most clipin the area of the pair of jaws, the pusher bar being longitudinallyslidable in response to actuation of the handle. The pusher bar ismovable between a first position wherein the distal end of the pusherbar is located proximally of the latchless surgical clip to be advanced,and a second position wherein the distal end of the pusher bar advancesthe latchless surgical clip to the jaw means.

The first transmission means acts on the pusher bar positioned withinthe endoscopic section and comprises a proximal pusher tube connected tothe proximal end of the pusher bar. The first pusher tube includesmounting means for rotatably connecting the pusher bar thereto. Themounting means of the pusher tube comprises a generally circular shapedprojection dimensioned for reception and engagement of at least onecooperating projection on the pusher bar.

The second transmission means acts on a channel member positioned withinthe endoscopic section, and comprises a proximal channel tube connectedto the proximal end portion of the channel member. The channel tubeincludes mounting means for rotatably connecting the channel tube to thechannel member. Links connect the second transmission means to a leveractuator and convert the rotational movement of the lever to linearmovement of the channel tube.

The jaw means preferably comprises a jaw blade fixed to the endoscopicsection and having a pair of distal spaced jaws which are resilientlymovable between a closed position for closing a latchless surgical clipand an open position for reception of the latchless surgical clip. Thecamming means is comprised of a channel member having camming surfacesmovable from a first position proximal of the jaws, and second distalposition wherein the camming surfaces of the channel member move thejaws to the closed position. The channel member is connected at itsproximal end to the channel tube.

The rotatable mounting means of the channel tube comprises acircumferential projection dimensioned for engaging at least onecooperating notch in the camming means. The endoscopic section isrotatable about a longitudinal axis extending relative to the framebetween a plurality of click-stop settings. Further, endoscopic sectionis preferably adapted to provide a gaseous seal means in the form ofsilicone grease.

A method is also disclosed for endoscopically applying latchlesssurgical clips with an apparatus having a frame adapted to be gripped byhand and an endoscopic section connected to the frame and rotatable toselected positions relative to the frame, comprising storing thelatchless clips in the endoscopic section, sequentially advancing a clipdistally by clip advancing means positioned within the endoscopicsection to a pair of jaws positioned at the distal end of the endoscopicsection and opening the clip therewithin, positioning the clip adjacentbody tissue to be clipped, closing the jaws about the clip whilepermitting the clip to close and simultaneously repositioning the clipadvancing means to a position proximal of the next clip to be advanced,and releasably locking the clip advancing means in that position untilreleased to advance the next clip.

BRIEF DESCRIPTION OF THE DRAWINGS

Preferred embodiments of the invention are described below withreference to the drawings wherein:

FIG. 1 is a perspective view of the disposable apparatus for placingclips in laparoscopic or endoscopic procedures constructed according tothe present invention;

FIG. 2 is a perspective view with parts separated for purposes ofillustration of the endoscopic section of the apparatus of FIG. 1;

FIG. 3 is a plan view from above, of the distal portion of theendoscopic section of the apparatus of FIG. 1 in its initial condition;

FIG. 4 is a cross-sectional view taken along lines 4--4 of FIG. 3illustrating the clip pusher in position to push the clip next in lineto a position between the jaws of the apparatus;

FIG. 5 is a plan view of the distal portion of the apparatus with theclip now advanced and partially opened;

FIG. 6 is a cross-sectional view taken along lines 6--6 of FIG. 5illustrating the distal portion of the apparatus in elevational view;

FIG. 7 is a plan view of the distal portion of the apparatus with theclip further advanced and in position for entry into and between thejaws;

FIG. 8 is an elevational cross-section view of the apparatus taken alonglines 8--8 of FIG. 6;

FIG. 9 is a plan view of the distal portion of the apparatus with theclip further advanced and now fully positioned between the jaws andready for closure onto body tissue;

FIG. 10 is an elevational cross-section view of the apparatus takenalong lines 10--10 of FIG. 9;

FIG. 11 is a plan view of the distal portion of the apparatus with theclip now fully closed onto body tissue;

FIG. 12 is an elevational cross-sectional view of the apparatus takenalong lines 12--12 of FIG. 11;

FIG. 13 is a cross-sectional view of the distal portion of the apparatustaken along lines 13--13 of FIG. 4;

FIG. 14 is a cross-sectional view of the apparatus taken along lines14--14 of FIG. 7;

FIG. 15 is a sectional view taken along lines 15--15 of FIG. 12;

FIG. 16 is a perspective view of the clip;

FIG. 17 illustrates a surgical operation for applying clips totubular-shaped body tissue;

FIG. 18 is a perspective view with parts separated for purposes ofillustration of the handle section of the apparatus of FIG. 1 utilizedfor activating the endoscopic section;

FIG. 18a is a perspective view of the rotatable collar;

FIG. 19 is an elevational cross-sectional view of the handle of theapparatus of FIG. 1 illustrating the apparatus in its initial prefiredcondition;

FIG. 20 is an elevational cross-sectional view of the handle of theapparatus of FIG. 1 with the trigger actuated to advance a clip to thejaws of the apparatus;

FIG. 21 is an elevational cross-sectional view of the handle section ofthe apparatus illustrating the actuation of the lever to close theinstrument jaws;

FIG. 22 is a cross-sectional view taken along lines 22--22 of FIG. 19and illustrating the trigger connection;

FIG. 23 is a cross-sectional view taken along lines 23--23 of FIG. 19and illustrating the channel tube and pusher member;

FIG. 24 is a view taken along lines 24--24 of FIG. 19 illustrating therack and pinion assembly; and

FIG. 25 is a cross-sectional view taken along line 25--25 of FIG. 19illustrating the lever linkages.

DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS

1. Preface

In the following description it should be noted that such terms as"distal" and "proximal", "upper" and "lower", "horizontal" and"vertical", "above" and "below", are used relative to each other and donot refer to positions or orientations relative to a frame of referenceexternal to the apparatus.

Because endoscopic procedures are more common than laparoscopicprocedures, the present invention shall be discussed in terms ofendoscopic procedures and apparatus. However, use herein of terms suchas "endoscopic", "endoscopically" and "endoscopic portion", among othersrefer generally to instruments having elongated and relatively narrowoperating portions for inserting into a cannula, body opening, or smallwound in the skin and should not be construed to limit the presentinvention to an apparatus for applying surgical clips only inconjunction with an endoscopic tube. To the contrary, the presentinvention may find use in any procedure where access is limited to asmall incision or body opening, including, but not limited tolaparoscopic procedures. In addition, in the preferred embodiment of theinvention the instrument is disposable. However, re-usable instrumentsare also contemplated.

2. Overview of the Apparatus

FIG. 1 illustrates a preferred embodiment of the apparatus of thepresent invention. The apparatus is preferably constructed as adisposable item of several materials as will be described. Essentially,however, two basic materials are used: a polycarbonate plastic such asLEXAN brand polycarbonate produced by General Electric Company, andstainless steel.

Briefly, the apparatus 10 includes two main sections: a handle section12, and an endoscopic section 14 which is distal of the handle section.The endoscopic section 14 of the apparatus is rotatable with respect tothe handle section 12 by turning knob 176 and is separable andreplaceable with another endoscopic section.

The apparatus has two actuators. A clip pushing system, which advances asurgical clip to jaw members 24, is operated by actuation of trigger 16by a single finger of the user's hand (e.g. the index finger). The clipclosing mechanism is actuated when lever 18 is squeezed towards handlegrip 202 by other fingers of the user's hand. The clip closing action ofthe jaws 24 is accomplished by translating longitudinal drive movementtransmitted through the endoscopic section 14 to lateral motion of jaws24, as described below.

3. The Handle Section

Referring now to FIGS. 18 and 19, the handle section 12 of the apparatusis illustrated with the transmission mechanism for manually activatingthe endoscopic section referred to above, i.e. for advancing clipsdistally and crimping the clips around a blood vessel or other tubularstructure. Handle section 12 includes a body 201 (FIG. 19), which housesthe actuation means of the apparatus. The body portion 201 includes ahandle 202 and an opening 203 for receiving the endoscopic section 14 ofthe apparatus. A bridge portion 204 is preferably extended over collar170.

The body 201 is preferably fabricated in halves which may then befastened together by fasteners such as screws or rivets. Alternativelythe body halves may be ultrasonically welded or adhesively attachedalong their seams or by bosses and transverse rods or pins in engagingrelation. The body 201 is preferably fabricated from a hard and durableplastic such as LEXAN polycarbonate material available from GeneralElectric Co. Other rigid materials are also contemplated, especiallymaterials capable of being molded into shape while being able to sustainthe forces applied by the transmission mechanism capable ofdemonstrating minimal dimensional changes due to temperature or stress.

The clip loading and crimping system is divided into two separatesystems as described in connection with the endoscopic section. Asnoted, a first system pushes the clip next in line from a row of clipsto a position within a pair of clamping jaws 24 as described inconnection with the endoscopic section of the apparatus. The secondsystem closes the pair of jaws 24 around the clips to cause the clip togrip the intended artery, tissue, or other blood vessel, whilesimultaneously repositioning the clip pusher mechanism to push the clipnext in line into position between the jaws. This procedure is repeatedalternately and sequentially until all clips are spent or the surgicaloperation is completed.

With reference to FIGS. 18 to 25, the clip pusher and clip closingactuation mechanisms will now be described. Lever 18 is an actuator forclosing the jaws 24 of the instrument and is pivotally mounted to thebody 201 by means of pin 104 extending transversely to the body anddisposed through aperture 108 in lever 18 (FIG. 18). The lever 18includes rearward extension 112 which includes aperture 126 throughwhich pin 110 extends. Pin 110 functions as a pivot for left channellink 116 and right channel link 118, which extend in a generally forwardor distal direction.

Lever 18 includes depending portion 113 having aperture 114 forreceiving one end of spring 106. The other end of spring 106 is attachedvia pin 105 to the interior of handle 202 of the body. Spring 106 biaseslever 18 clockwise as seen from the instrument orientation as shown inFIG. 19. Actuation of lever 18 requires counter clockwise pivoting ofthe lever by the fingers of a user's hand. Thus, actuation of lever 18is accomplished against the biasing force of spring 106.

Left and right channel links 116 and 118, respectively, each includeapertures 116a and 118a, respectively, for receiving pin 110. Upperapertures 116b and 118b in the respective left and right channel linksare pivotally mounted to bosses 127 and 129, respectively, of channeltube 124. Thus, actuation of lever 18 causes channel links 116 and 118to push channel tube 124. Thus, actuation of lever 18 causes channellinks 116 and 118 to push channel tube 124 distally.

Channel tube 124 is an elongated member having a distal opening 123 forreceiving the proximal end of the crimping channel 32 by snap fitengagement of the legs, or prongs 92. Channel tube 124 includes acentral longitudinal passage 128 for receiving pusher member 134, whichis slidably disposed therein.

Referring again to FIGS. 18-25, trigger 16 is an actuator for advancingthe clips to the instrument jaws in response to finger pressure appliedby a user of the instrument. Trigger 16 includes tabs 16a which areslidably mounted in corresponding slots 206 in the interior surface ofbody portion 201 (FIGS. 19, 20, 22). Attached to trigger 16 is extensionmember 164 which includes a lower gear rack 165. Pinion gear 166 ispivotally mounted to the body 201 and is positioned above rack 165,which it cooperatively engages. Pinion gear 166 also engages upper rack135 such that when lower rack 165 moves proximally, upper rack 135 movesdistally. Upper rack 135 is fixedly mounted to rack holder 145 andpossesses front and rear apertures 136a and 136b, respectively. Rearaperture 136b receives the distal end of spring 148. Front aperture 136areceives pin 119. Rack holder 145 includes flaps 146 which are slidablymounted in corresponding slots in body 201, and aperture 147 forreceiving pin 119. Spring 148 is for biasing the upper rack (and theclip pushing transmission) to the proximal position. The proximal end ofthe spring 148 is mounted to cross pin 149, which is fitted to body 201,and the distal end of spring 148 is mounted to aperture 136b of theupper rack.

Pusher member 134 includes a distal opening 133 for receiving forkedproximal end 90 of clip pusher bar 78 by snap fit engagement. Pushermember 134 also includes sides 131 and 132 defining a central passage,and apertures 137 through which pin 119 is disposed. Thus, pin 119fastens pusher member 134, rack holder 145, and upper rack 135 byextending through apertures 137, 147 and 136a.

In operation, proximally pulling trigger actuator 16, as shown in FIG.20, causes lower rack 165 to move proximally. Pinion gear 166 thereuponconverts the proximal motion of lower rack 165 to the distal motion ofupper rack 135 along with the remainder of clip pushing transmissionsystem (rack holder 145, pusher member 134, pusher bar 78) for advancingthe distal-most clip in a row of stored clips to the jaws.

When trigger 16 is released, upper rack 135 and its associatedstructures are biased back to their proximal position by means of spring148 and trigger 16 is biased forward.

Referring to FIG. 21, squeezing lever 18 towards handle 202 causespivotal movement of channel links 116 and 118 which translates toforward longitudinal motion of channel tube 124.

4. The Rotational Linkage

Referring now to FIG. 3 in conjunction with FIG. 2 and FIGS. 19 and 18a,the feature relating to the rotatable endoscopic section will bedescribed. Rotating collar 170 is constructed of the same material asthe handle, i.e., preferably a polycarbonate material such as LEXANbrand material. This collar 170 includes a distal cylindrical nosesection 172 and a proximal barrel section 174. The proximal face of thebarrel section 174 preferably includes a plurality of proximallyextending teeth 176 positioned circumferentially about the proximal faceof the barrel section, and the cylindrical nose section 172 includes aninwardly extending rib 178 at the distal end for engaging groove 15a ofupper endoscopic cartridge half 15. In the assembled condition, thecylindrical nose section rests within the cylindrical distal bore 182 ofthe distal end of the handle and nose piece 184 is fitted over thedistal cylindrical end of the handle 12 as shown, for example, in FIGS.19 and 20. Bearing washer 186 and spring washers 188, 190 are positionedbetween shoulder 192 of collar 170 and shoulder 194 formed in the handlebody to bias the rotatable collar in the proximal direction causingtooth 180 on the handle body to engage the teeth 176 of the collar 170to thereby fix the rotatable orientation of the collar. When the surgeondesires to change the angular orientation of the endoscopic section, thecollar 170 is merely pushed distally to disengage tooth 180 to free thecollar and permit rotation relative to the handle body. Such rotation ofthe collar is clearly permitted by the fact that the cylindrical nosesection of the collar is fit snugly within the corresponding cylindricaldistal section 182 of the handle. Except when the tooth 180 of thehandle body is engaged with teeth 176 of collar 170, the collar isotherwise free to rotate within the handle.

Referring now to FIG. 2 in conjunction with FIGS. 1, 18a and 19, thedistal cylindrical section 172 of collar 170 includes a distalcylindrical opening dimensioned to receive the endoscopic cartridgeformed of upper half 15 and lower half 17 of endoscopic section 14, withdistally positioned tooth 178 of collar 170 positioned withinlongitudinally extending groove 15a of upper cartridge half 15 to causethe cartridge to rotate with the collar 170. Similarly, the proximallegs 90 of clip pusher bar 178 are permitted to rotate within the distalend portion 133 of pusher tube 134 and the proximal legs 92 of thecrimping channel 32 are permitted to rotate within the distal endportion 123 of channel tube 124. Thus, the entire endoscopic section maybe selectively rotated by the surgeon by simply pushing collar 170 inthe distal direction sufficient to disengage tooth 180 on the handlebody and by rotating the collar 170 until the endoscopic section reachesthe desired angular orientation. Thereafter, by merely releasing thecollar the bias of spring washers 190, 188, causes the collar to moveproximally, such that tooth 180 on the handle body engages theappropriate teeth 176 on the collar 170 to lock the position of thecollar and the endoscopic section.

5. The Latchless Clip

Unlike the latching, or locking, surgical clips of the prior art, thelatchless clip of the present invention provides a tissue clamping forcewhich is self-adjusting for a variety of tissue types and tissuethicknesses. The ability of the latchless surgical clip to readilyaccommodate different tissue clamping situations with no appreciablerisk of tissue injury represents a significant advantage over thelatching, or locking, surgical clips of the prior art.

Referring to FIG. 16, latchless surgical clip 22 is provided as a singlemolded substantially planar polymeric clip body possessing two legs 44joined at one end through hinge back region 45. Latchless surgical clip22 is molded, e.g., by injection molding, in an open or pre-applicationconfiguration, i.e., with legs 44 spaced apart from each other. Asmolded, polymeric latchless clip 10 is substantially amorphous, i.e.,the molded polymer exhibits less than 10% crystallinity. After moldingin this open configuration, latchless clip 10 is treated so as to imparta spring-back property to hinge region 14.

A preferred post-molding clip treatment process of the latchless clip 22shown in FIG. 16 involves heating the clip 22 to a temperature whichpermits legs 44 to be moved or deflected into a second position which isdifferent from the as-molded position. Inasmuch as molded clip 22 issubstantially amorphous, clip 22 is typically heated to a temperature ator above the glass transition temperature of the polymeric material fromwhich it is fabricated. Once at or above its glass transitiontemperature, the substantially amorphous polymer is soft or rubbery,thereby facilitating movement of legs 44 to a second position. Oncedeflected to this second position, clip 10 is further heated to atemperature at which crystallization of the polymer commences. In orderto achieve the desired spring back property in hinge back portion 45,polymeric clip 22 is typically maintained at a crystallizationtemperature for a time sufficient to develop at least 20% crystallinitypreferably at least 30% crystallinity, and most preferably at least 40%crystallinity.

The post-molding treatment of clip 22 typically results in a minordegree of shrinkage of the clip body, and typically causes a rounding ofany sharp edges present on clip body. However, neither the shrinkage northe rounding impinges upon the clinical efficacy of the device and,indeed, the rounding of sharp edges is generally desired to reduce thelikelihood of tissue puncture or laceration upon clip application.

After sufficient crystallization is accomplished, clip 22 is cooled toambient temperature. Clip 22 remains oriented in its second positionabsent an external biasing force away from said second position. Theabove-described post-molding treatment imparts an elastic spring backproperty to hinge region 45 such that when a biasing force is applied tolegs 44, e.g., a force biasing legs 44 away from each other, and thenwithdrawn, legs 44 spring back toward each other, i.e., to or towardtheir second (pre-spread) positions.

The flexural strength of the latchless clip of the invention may beincreased through a post-flexing process after the clip has been subjectto a post-molding treatment to achieve the desired degree ofcrystallinity and of spring back property in the hinge region.Post-flexing involves repeatedly and temporarily biasing the legs apartthrough application of a temporary biasing force at an elevatedtemperature, e.g., 30°-50° C. Such post-flexing treatment has been foundto lessen the internal stresses experienced by the clip when beingapplied to tissue at ambient temperature.

A wide variety of polymeric materials may be used to fabricate latchlessclip 22 of the present invention. The principal requirement of thepolymer is that it develop sufficient crystallinity upon movement to asecond position to impart a sufficient spring back force to hinge region45. Of course, the required spring back force will vary depending on theintended application of clip 22. Among the materials which are suitablefor the manufacture of clip 10 are non-bioabsorbable polymers such asthe polyesters, polyamides, polycarbonates, polyvinyl chloride,polysulfones, and polypropylenes. Suitable bioabsorbable polymersinclude homopolymers and copolymers of lactide, glycolide, trimethylenecarbonate, caprolactone, and p-dioxanone, and blends thereof. Apreferred bioabsorbable polymer is a copolymer derived fromapproximately 80 to 95 weight percent glycolide and 5 to 20 weightpercent lactide.

In one preferred embodiment of the present invention, each leg 44possesses upper and lower parallel rows of spaced-apart staggeredtooth-like projections 46, which cooperatively engage the correspondingrows of projections on the other leg. Although the projections are shownto be substantially rectangular in shape, clearly projections of otherconfigurations and sizes could be utilized. Additionally, a smaller orgreater number of projections than are shown may be utilized to achievethe interfitting arrangement of the projections to enhance clipsecurement. It is also contemplated that spaced projections may belimited to the tissue clamping surface of one leg, these projectionsbeing adapted to cooperate with the tissue clamping surface of theopposing leg to effectively secure clip 22 to tissue.

Latchless clip 22 is applied by a device such as the one describedherein, which possesses means for temporarily resiliently biasing legs44 apart by clip opening means and placing the open clip into positionat a desired tissue site. Clip 22 may be provided with upwardlyextending pins 49a and an instrument can be utilized which grasps theclosed clip in its jaws and, following engagement with pins 49aresiliently biases the legs apart the required amount to allowapplication of the clip to the desired tissue site, e.g., by directing apushing force against the pusher post 48, which brings the clip intoengagement with the body tissue. Once applied to the site, the biasingforce is withdrawn whereupon legs 44 return to the closed, or tissueclamping, configuration thereby providing effective hemostasis.

Referring once again to FIG. 16, post 48 extends upward from the centerof the proximal portion 45 and serves as a pusher post. Post 48 isengaged by clip pusher 78 for advancing clip 22 when clip pusher 78 ismoved distally. Lower projection 43 engages slot 67d of the track 66 toserve as a guide for proper orientation of clip 22 as it is advanced.Posts extend upward and downward from the legs 44. Upper posts 49aengage the clip pusher 78 for advancing the clip 22, and lower posts 49bserve as spreader posts for interaction with the clip opening means,which comprises a track portion having at least one, and preferably twocamming surfaces 67a and 67b positioned such that upon distal advancingof the clips the lower posts 49b contact the camming surfaces and arelaterally moved to a more spaced apart configuration. As lower posts 49bcam against surfaces 67a and 67b (as explained below with reference toFIG. 3) the legs 44 spread apart. Notches 47 extend along the outsidesurface of legs 44.

The clips of the present invention may be constructed in various sizesaccording to their intended function. For example, for a latchless clipto be used in hemostatically occluding a blood vessel, a length of about1 cm, a width of about 5 mm and vessel clamping surface of about 5 mm inlength are typical. The dimensions may be reduced as appropriate, e.g.,by about 50%, for microsurgical applications. Conversely, the dimensionsmay be increased as appropriate, e.g., by about 100% for femalesterilization, in which oviduct occlusion is desired. For malesterilization, occlusion of the vas deferens may be accomplished withsmaller clips. The clip can be molded in various colors to increasecolor contrast with surrounding tissue and/or to facilitateidentification of the size of the clip.

The clip body, particularly the hinge region and legs, of the latchlesssurgical clip of the invention possesses sufficient resilience to permitthe clip legs to be deflected apart an appropriate distance to allow theclip to be easily and efficiently placed on or around the desiredtissue. Generally, the clip body is sufficiently resilient to permit thelegs to be deflected to a position wherein the legs are separated by anangle of from 15° to 50°, and more typically an angle of from 20° to35°. This angle of maximum deflection will depend on such factors as thepolymeric material, the degree of crystallinity of the clip body afterthe 15 post-molding treatment, the physical dimensions of the clip body,the presence of cored sections, and whether the clip body hasexperienced post-flexing. The angle of maximum deflection may correspondto, but is not necessarily restricted to, the angular opening of thelegs in the as-molded configuration.

The hinge region also possesses a sufficient spring back force to bringthe legs toward each other (once the external biasing force is removedfrom the legs) to apply an effective tissue clamping force to thetissue. The tissue clamping force which the clip must deliver willdepend on such factors as the type and size of the tissue to which it isto be applied. Typically, in order for the clip to effectively occlude atissue structure, e.g., a blood vessel, the clip should apply a residualforce of about 0.5-1.0 psi once placed on the tissue structure. Onceplaced on tissue, the hemostatic latchless clip of the inventionmaintains that position for a period of time sufficient to permithemostasis to take place, i.e., maintains its strength in vivo so as towithstand the internal pressure which is trying to force the tissuestructure back open until the natural, permanent sealing of the tissuestructure is complete.

6. The Endoscopic Section

Referring now to FIG. 2 in conjunction with FIGS. 3 to 14 and FIG. 1,the endoscopic section 14 of the apparatus will now be described. Theendoscopic section 14 is preferably housed in a non-removable cartridgeformed of upper half 15 and lower half 17. Each half section is formedof a material capable of withstanding the stresses applied to the innerworking compartments without deformation or compromise of precision. Apolycarbonate material such as LEXAN brand material marketed by GeneralElectric Corporation has been found to satisfy the requisite strengthand deformation requirements. Other suitable materials may be used. Ifdesired, the cartridge can be constructed to be removable from thehandle.

The lower housing half section 17 includes upstanding tabs 17a and theupper housing half section 15 includes correspondingly positioned slots(not shown) which are configured and dimensioned to receive tabs 17asuch that the two half sections may be attached by ultrasonic weldingtechniques. Preferably, the slots are dimensioned to receive the tabs17a in interference relation to assist securement of the half portionstogether. Alternatively, the half sections may be adhesively attached.Further, upper half section 15 includes longitudinally extending slots15a which receive correspondingly dimensioned ribs in the collar of thehandle section to facilitate rotation of the endoscopic section with thecollar. Referring once again to FIG. 2, a plurality of U-shapedlatchless clips 22 are positioned within the housing for movement in thedistal direction in preparation for the clamping procedures. The clips22 are aligned in a row as shown, with the leg portions facing distally.A jaw blade 26 is positioned at the distal end and includes a pair ofjaws 24 for reception of each clip. Although the clips 22 are resilientand automatically snap back into a closed position after being releasedfrom an open position, it should be remembered that during use the clipswill have body tissue positioned between the clamping surfaces of thelegs. Therefore, it is desirable to provide additional closing force tofacilitate complete clamping of the body tissue by the clip. Thisadditional force is applied to the outer edges of the clip legs by jaws24.

One feature of the present invention is to bias the surgical clipstoward the distal direction and to sequentially advance each clip intothe jaws after the jaws have been positioned about an artery.Thereafter, the jaws are closed and both legs of the "U" shaped clip arebrought together to sufficiently close the artery as shown in FIGS. 11,12, and 16.

The jaw blade 26 is fabricated of a material having sufficientresilience such that clamping of the distal pair of jaws 24 toward eachother to close a clip therebetween will be followed by return of thejaws to their original position upon release of the clamping forces.Stainless steel has been found to be a preferred material capable notonly of withstanding the requisite number of clamping cycles withoutadverse effect, but also of being suitably sterilized. Furthermore, jawblade 26 includes one or more square shaped apertures 28 dimensioned toreceive three correspondingly shaped pins 30 molded into the lower bodyhalf section 17 of the housing to position the jaw blade 26 with respectto the body.

Referring further to FIG. 2, crimping channel 32 is dimensioned andpositioned for slidable movement within the body of the housing and hasupraised side walls 34 along the sides and further has a slot 36 at thedistal end for reception of square pins 30. The width of the slot 36 ofcrimping channel 32 is sufficient to receive the pins 30 to maintainrelative alignment between the jaw blade 26 and the pins 30. A channelbracket 38, also preferably of stainless steel, is positioned atop thejaw blade and defines two downwardly extending side walls 40, 42positioned to be welded to the distal portions of correspondinglypositioned and dimensioned upwardly extending side walls 34 of crimpingchannel 32. It will be appreciated that the crimping channel 32 formswith channel bracket 38, a rectangular slidable housing surrounding thejaws 24 of jaw blade 26. Moreover, since the jaw members 24 are formedof outwardly tapered side walls having camming surfaces 50, 52, distalmovement of the crimping channel 32 will cause inward movement of thejaw members, while proximal movement of the crimping channel will resultin corresponding proximal movement of channel bracket 38 therebyrelieving the jaw members 24 of the crimping forces and permitting thejaw members to resiliently open.

Referring now to FIGS. 2 and 3, jaw members 24 include inner edges 54,56 dimensioned to receive a clip 22 therebetween for clipping a bodyportion. Tissue stop plate 60 shown in FIG. 2, is positioned between jawblade 26 and crimping channel 32 and includes aperture 62 at theproximal end portion for reception of an appropriate pin (not shown)which extends through the jaw blade 26 and tissue stop plate 60 tomaintain alignment of the jaw blade 26 and the tissue stop plate 60 whenthese components are welded together. At the distal portion of thetissue stop plate a tab 64 is oriented at approximately the samedownward angle as the jaws 24 for alignment therewith arid includes anarcuate cut-out portion as shown, dimensioned to snugly receive anartery for locating and positioning the artery in the precise areawithin the jaw blades as required for applying a clip to the artery withpredetermined precision. The tissue stop plate is preferably fabricatedof a thin stainless steel sheet material.

Support plate 57 is positioned underneath the tissue stop plate 60 andincludes an upwardly bending distal section 58 which supports the tab 64at the distal end of tissue stop plate 60, and proximal walls 59 whichextend partially around the outer edges of the jaws 24.

Referring further to FIG. 2, track member 66 is appropriatelydimensioned to rest atop the clip clamping mechanism describedhereinabove, and supports the row of clips 22. Proximally of clips 22 ispositioned a clip follower 68 which is "U" shaped at the distal end tosnugly engage and advance the clips under the action of clip feed spring72, the distal end of which is connected to the proximal end of clipfollower 68 and the proximal end of which is mounted to pin 74. Pin 74is in turn connected to pusher bar support 76 while clip pusher bar 78is positioned for slidable movement thereon between a proximal positionand a distal-most position. Clip pusher 78 includes forked nose section80 and a depending catch 87 (see FIGS. 6 and 8) for engaging the uprightrear post 48 of the clip. When upright rear post 48 of the next clip 22is engaged by catch 87 in the distal nose 80 of clip pusher 78, distalmovement of the clip pusher 78 advances the clip between the edges 54,56 of jaws 24 which engage slots 47 along the sides of the clip 22. Asclip 22 advances, lower spreader posts 49b cam against the distal wedgesurfaces 67a and 67b of spreader portion 67 of track 66. This actionforces open clip legs 44 from an initially closed position to an openposition. When the clip moves beyond the distal edge of the spreaderportion 67 of the track 66 the lower spreader posts 49b no longercontact the distal wedge surfaces 67a and 67b, thereby permitting theclip legs to close. The clip legs close due to the resilience of thematerial from which the clip is fabricated with the assistance of theclosing force applied by jaws 24.

When all the clips have been applied, clip follower 68 advances toridges 67c of track member 66. Slots 84 on the sides of the distalportion 70 of clip follower 68 engage ridges 67c and the follower distalportion 70 is stopped when stopping shoulder 82 abuts the proximal edgeof ridges 67c.

Referring again to FIG. 2, by sliding clip pusher bar 78 between theproximal and distal positions, the clip pusher bar may be alternatelypositioned with nose 80 behind each successive clip, and thereafteradvancing the clip into the jaws 24 of jaw blade 26 by pusher mechanismin handle section 12 which will be described. The connection between themechanism in the handle 12 is made with the proximal end portion 90 ofclip pusher 78 which extends into the handle section. Further, theconnection between the appropriate link of handle 12 with the crimpingmechanism of jaw blades 24 is made with the proximal end portion 92 ofcrimping channel 32 as will be described. The precise action of thehandle 12 and its inner mechanism is such that proximal force applied totrigger 16 causes clip pusher 78 to push the next clip 22 into the jaws24 while simultaneously releasing the crimping channel 32 to the "ready"position for crimping the clip. Next, the operator squeezes handle 18toward hand grip 20 which causes crimping channel 32 to move distally tocrimp the clip positioned within jaws 24, while simultaneously movingclip pusher 18 proximally in position to push the next clip 22 into thejaws 24. These movements are alternately repeated until the last clip 22is spent.

7. Operating Sequence

A. Handle Section

Referring now to FIGS. 19-22, the clip advancing and jaw squeezingmechanisms are shown in various stages of the operation. FIG. 19 is anelevational cross-sectional view of the handle 12 of the apparatus,illustrating the pusher tube 134 in the proximal-most positioncorresponding to the position of the pusher bar 78 shown in FIG. 4,i.e., with the nose 80 just proximal of the next clip 22 in readiness toadvance the clip distally into the jaws 24. Additionally, with pushertube in the proximal position, downwardly extending pin 158 has movedout of engagement with latch 150 thereby permitting tongue 156 to enterthe aperture of channel latch plate 146 thus preventing any distalmovement of channel tube 124. This condition locks handle 18 in thedistal position whereby squeezing the handle toward hand grip 20 isprevented.

Referring now to FIG. 20, there is shown a cross-sectional view of thehandle 12 of the apparatus with the pusher tube in the distal-mostposition corresponding to the position of pusher bar 78 as shown in FIG.10, i.e., with the clip 22 advanced distally into the jaws 24 of jawblade 26 As can be seen further in FIG. 20, the distal position ofpusher tube 134 has now resulted in release of tongue 156 of latch plate150 from the aperture of channel latch plate 146 in the bottom wall ofchannel tube 124 thereby permitting advancement of channel tube 124 andcrimping channel 32 distally to squeeze jaws 24 in conjunction withchannel bracket 38.

Referring now to FIG. 21, a cross-sectional view of the handle 12 isshown after the crimping action has taken place on clip 22 positionedwithin jaws 24. The position of the components shown in FIG. 21corresponds to the position of the jaws shown in FIG. 11, i.e., in theclamped position about clip 22. In the cross-section shown in FIG. 21,the pusher tube 134 is in the proximal-most position and the channeltube is in the distal-most position such that crimping channel 32 andchannel bracket 40 are in the distal-most position.

Referring to FIG. 22, a cross-sectional view of the handle 20 is shownafter the last clip 22 has been spent.

Referring once again to FIG. 18 in conjunction with FIGS. 19-22, lostmotion spring 210 is shown having transverse arms 212 and tab 214.Spring 210 provides bias force on pusher links 120, 122 such thatsqueezing action on handle 18 maximizes proximal movement of pusher tube134. Thus, partially closing the jaws 24 of jaw blade 26 will causepusher tube 134 to move sufficiently proximal to make certain thatpusher bar 78 has moved proximally of the next clip 22. Without suchmovement it may be possible for the surgeon to squeeze the jaws, notfully appreciating that the pusher bar 78 has not moved to a positionproximal of the next clip 22. This proximal movement of the pusher baris thus assisted by lost motion spring 210 which maximizes therepositioning movement of the pusher bar 78 behind the next clip whetherthe jaws are squeezed fully or partially. In particular, the proximalbias provided by spring 210 on pusher links 120, 122 maximizes themovement of the pusher tube 134 in relation to the movement of handle 18by maintaining pusher links: 120, 122 in their proximal-most positionsprior to squeezing the handle 18. This maximum proximal movement ofpusher links 120, 122 in turn results in proximal movement of pushertube sufficient to engage tongue 162 of release spring 160 thus makingcertain that pusher bar 178 is repositioned sufficiently proximally toadvance the next clip 22 into the jaw members 24.

B. The Endoscopic Portion

Referring now to FIGS. 3 to 10, the operation of the endoscopic portionof the instrument is shown. More particularly, FIGS. 3 and 4 illustratethe initial condition of the instrument. The latchless clip follower 68,biased by spring 72, urges latchless clips 22 distally. Clip pusher 78with forked nose 80 and catch 87 is positioned proximal to thedistal-most clip. Tissue 200 to be clipped is located between jaws 24and abuts tab 64 of tissue stop 60. The distal end 67 of clip track 68possesses inclined camming surfaces 67a and 67b for contacting theupright leg posts 49 of the latchless clip 22. A central alignment slot67d receives depending alignment post 43 of the latchless clip 22 andmaintains the clip in alignment as it is advanced distally. FIG. 13shows a sectional view of the distal portion of the apparatus asindicated.

Referring now to FIGS. 5 and 6, as the clip 22 is advanced, spreader legposts 49b cam against surfaces 67a and 67b thereby opening legs 44 ofthe clip 22. Depending alignment post 43 rides in slot 67d.

As shown in FIGS. 7, 8, and 14, clip 22 is advanced further and the cliplegs 44 are fully opened. The clip begins to enter the jaws 24 and theedges 54 and 56 of the jaws engage side slots 47 of the clip to maintainproper alignment. Clip 22 is advanced fully into the jaws 24 and ispositioned for application to tissue 200 as shown in FIGS. 9 and 10.

Referring now to FIGS. 11 and 12, the clip closing mechanism isactivated, as explained above, and jaws 24 of the instrument are closed,thereby closing latchless clip 22 around tissue 200, as illustrated inFIG. 15. The latchless clip 22 remains closed. Hence, when the jaws 24reopen, clip 22 is released from the jaws 24.

An illustrative example of an operation which may be performedendoscopically on body tissue is shown in FIG. 17, wherein clip applier10 applies a series of latchless clips 22 to body tissue 200.

What is claimed is:
 1. An apparatus for endoscopic application ofsurgical clips to body tissue, which comprises:a) a frame, b) endoscopicmeans of generally elongated configuration defining a longitudinal axisand connected to said frame and extending distally therefrom, saidendoscopic means including a tubular housing defining an internalpassage and having a distal end portion, and further including:(i) meansfor storing a plurality of surgical clips in the internal passage ofsaid tubular housing and a plurality of surgical clips stored in saidstoring means, each of said surgical clips possessing a pair of legswhich are movable between a first position wherein said legs are inrelatively close proximity with each other, a second open positionwherein said legs are relatively spaced apart from each other, and athird closed position wherein said legs are in relatively close engagedrelation with tissue gripped therebetween, said legs being resilientlybiased toward said first position, said surgical clips being stored insaid storing means in said first position, (ii) clip opening meanslocated in the internal passage of said tubular housing for moving saidsurgical clip legs from said first position to said second openposition, (iii) clip advancing means movable within the interior passageof said tubular housing for individually distally advancing saidsurgical clips to a location wherein said clips are permitted to atleast partially surround body tissue when said clip legs are in saidsecond open position; and (iv) means positioned at said distal endportion of said tubular housing for moving said clip legs to said thirdposition to effect closure of said surgical clips at least sufficient togrip the body tissue.
 2. The apparatus of claim 1, wherein said surgicalclip legs possess opposing tissue clamping surfaces and tissue clampingmeans on said tissue clamping surfaces, said tissue clamping means ofone leg being cooperatively engageable with said tissue clamping meansof the other leg to impart a tissue clamping force to body tissuepositioned therebetween.
 3. The apparatus of claim 1, wherein saidsurgical clip includes at least one projection on each of said legs. 4.The apparatus of claim 3, wherein said clip opening means comprises atrack portion having at least one camming surface positioned such thatupon distal advancing of said clips said projections contact saidcamming surface and are laterally moved to a more spaced apartconfiguration.
 5. The apparatus of claim 1, wherein said surgical clipseach have at least one projection for engagement by said advancingmeans.
 6. The apparatus of claim 5, wherein said clip advancing meanscomprises a fork shaped distal end portion for engaging said projectionof the clip.
 7. The apparatus of claim 1, wherein said surgical clipsare stored in said clip storing means in a row aligned with thelongitudinal axis of the instrument.
 8. The apparatus of claim 1,wherein said means for effecting closure of the surgical clip comprisesjaw means positioned at the distal end of the endoscopic means.
 9. Theapparatus of claim 8, wherein said clip advancing means advances thesurgical clips to a position between said jaw means for positioningadjacent to the body tissue to be clipped.
 10. The apparatus accordingto claim 9, wherein said frame comprises an instrument body and anactuating handle mounted to said instrument body.
 11. The apparatusaccording to claim 10, wherein said frame contains first transmissionmeans for linearly transferring motion from said actuating handle tosaid clip advancing means.
 12. The apparatus according to claim 11,wherein said frame contains second transmission means for linearlytransferring motion from said actuating handle to said jaw closingmeans.
 13. The apparatus according to claim 11, wherein said endoscopicsection is rotatable independent of said handle.
 14. The apparatusaccording to claim 11, further comprising means for locking said handlesuch that after actuating said handle to close said jaws, said handlecannot be actuated unless said locking means is released.
 15. Theapparatus according to claim 14, wherein said handle locking meanscomprises a first resilient catch movable in response to actuation ofsaid handle from an unlocked position to a locked position wherein firsttransmission means is advanced and locked, release means adapted torelease said first resilient catch, said first resilient catch beingreturnable to the unlocked position in response to actuation of saidrelease means, and a second resilient catch movable in response toactuation of said handle from an unlocked position to a locked positionwherein it engages and locks second transmission means, said secondresilient catch being resiliently returnable to the unlocked position inresponse to the release of said resilient catch.
 16. The apparatusaccording to claim 8, wherein said jaw means comprises a pair of jawspositioned in spaced relation and configured and dimensioned forreception of a surgical clip therebetween, said jaws each having a clipcontacting edge adapted to engage a corresponding notch on the outeredge of the clip, said jaws being resiliently movable toward and awayfrom each other in response to longitudinal movement of a camming meansbetween a proximal position and a distal position.
 17. The apparatusaccording to claim 16, wherein said camming means comprises a channelmember slidably mounted within said endoscopic section andlongitudinally movable in response to actuation of said handle, saidchannel member having at least two distal camming surfaces for biasingthe jaws into said closed position.
 18. The apparatus according to claim1, wherein said means for storing surgical clips comprises a track forholding a longitudinal array of surgical clips, and spring means locatedproximal to the array of surgical clips for biasing said surgical clipstoward the distal direction.
 19. The apparatus according to claim 18,further comprising a clip follower and a clip track positioned betweensaid jaw means and said clip follower.
 20. The apparatus according toclaim 1, wherein said means for advancing the surgical clips comprises apusher bar for advancing the distal-most clip into said means for movingsaid clip legs to said third position, said pusher bar beinglongitudinally slidable in response to actuation of said handle.
 21. Theapparatus according to claim 1, wherein said endoscopic section includesa gaseous seal means.
 22. An apparatus for endoscopic application ofsurgical clips to body tissue, which comprises:a) a frame configured anddimensioned for manual gripping, b) an endoscopic shaft of generallyelongated configuration defining a longitudinal axis and connected tosaid frame and extending distally therefrom, said endoscopic shaftincluding a tubular housing defining an internal passage and having adistal end portion, and further including:(i) means for storing aplurality of surgical clips in the internal passage of said tubularhousing and a plurality of surgical clips stored in said storing means,each of said surgical clips possessing a pair of legs which are movablebetween a first position wherein said legs are in relatively closeproximity with each other, a second open position wherein said legs arerelatively spaced apart from each other, and a third closed positionwherein said legs are in relatively close engaged relation with tissuegripped therebetween, said legs being resiliently biased toward saidfirst position, said surgical clips being stored in said storing meansin said first position, (ii) clip opening means located in the internalpassage of said tubular housing for moving said surgical clip legs fromsaid first position to said second open position, (iii) clip advancingmeans movable within the interior passage of said tubular housing forindividually distally advancing said surgical clips to a locationwherein said clips are permitted to at least partially surround bodytissue when said clip legs are in said second open position; and (iv)means positioned at said distal end portion of said tubular housing formoving said clip legs to said third position to effect closure of saidsurgical clips at least sufficient to grip the body tissue.
 23. Adisposable apparatus for endoscopic application of latchless surgicalclips to body tissue, said clips each having a pair of legs normallybiased toward a first position wherein said legs are in relatively closeproximity with each other, and resiliently movable toward a second openposition which comprises:a) a frame adapted to be gripped by hand; b) anelongated endoscopic section connected to said frame, said endoscopicsection comprising a tubular housing with a distal end portion andfurther including:i) means for storing a plurality of latchless clips inthe interior of said tubular housing; ii) a pair of jaws at the distalend portion of said tubular housing, said jaws being configured anddimensioned for reception and clamping of said latchless surgical clips;iii) means extending through the interior of said tubular housing foradvancing said latchless surgical clips into said jaws; iv) meanslocated in said tubular housing for causing said legs to move towardsaid open position to facilitate positioning of said clip about bodytissue to be clipped; and v) means for moving said jaws toward eachother for closing a clip positioned therebetween.
 24. A method forendoscopically applying latchless surgical clips with an apparatushaving a frame adapted to be gripped by hand and an endoscopic sectionconnected to said frame, comprising:a) storing a plurality of saidlatchless surgical clips in said endoscopic section, each of Saidlatchless surgical clips having a pair of legs resiliently biased towarda closed position and movable away from each other to an open position;b) distally advancing one of said latchless surgical clips to a pair ofjaws positioned at a distal end of said endoscopic section by clipadvancing means positioned within said endoscopic section; c)positioning said latchless surgical clip adjacent body tissue to beclipped; d) closing said jaws about said latchless surgical clip whilepermitting said clip legs to move toward the closed position, andsubstantially simultaneously repositioning said clip advancing means toa position proximal of the next clip to be advanced; and e) releasablylocking said clip advancing means in said proximal position untilreleased to advance the next clip. .Iadd.
 25. An apparatus forendoscopic application of surgical clips to body tissue, whichcomprises:a) a frame; b) an elongated body portion extending distallyfrom the frame and having a distal end portion, the elongated bodyportion defining a longitudinal axis and an internal passage therein; c)a storage magazine defined within the internal passage of the elongatedbody portion configured to retain a plurality of surgical clips; d) aplurality of surgical clips positioned in the storage magazine, each ofthe surgical clips having a pair of legs movable between an approximatedposition wherein the legs are in approximation and an open positionwherein the legs are spaced apart, the legs being biased towards theapproximated position, the surgical clips being stored in the storagemagazine in the approximated position; e) a clip advancer movablymounted relative to the body portion, at least a portion of the clipadvancer positioned within the internal passage; f) first and second jawstructure mounted adjacent said distal end of the elongated body portionand defining a tissue receiving space therebetween; g) at least onecamming surface at least partially disposed adjacent the first andsecond jaw structure, wherein said at least one camming surfaceprogressively cams the legs of the surgical clips towards the openposition and said at least one camming surface permits the legs of thesurgical clip to subsequently move towards the approximated positionwhile said surgical clip is at least partially within the tissuereceiving space. .Iaddend.